The only type of treatment that has been found to be broadly effective for hoarding is cognitive behavioral therapy (CBT). The form of CBT that seems to work fairly well for hoarding includes the following elements: motivational interviewing, several features of cognitive therapy and behavioral practice, and skills training.
The treatment focuses on three hoarding behaviors: excessive acquisition, difficulty discarding or letting go of possessions, and disorganization and clutter that impairs functioning.
The treatment is designed generally to be undertaken in 26 weekly sessions with some sessions completed in the clients’ home. The amount of improvement appears to be related to how much homework clients complete.
The first four sessions focus on education about hoarding and the cognitive behavioral model, including efforts to enhance motivation. Acquisition problems are the topic for sessions 5 and 6. During this portion of the workshop participants attempt non-acquiring trips in which they expose themselves to progressively stronger acquiring triggers in order to learn to tolerate urges to acquire. The following four sessions involve cognitive restructuring exercises and practice in imagined and actual discarding situations. Participants are assigned to complete daily sorting and discarding sessions. The final three sessions address difficult discarding and acquiring issues and prepare participants to continue working on their hoarding after the end of the program.
Sessions each begin with a check on homework progress and end with a new homework assignment.
Treatment Choice and sequencing of Treatment
Based on the limited data, CBT should be the treatment of choice for Hoarding Disorder. Patients should be started with CBT and medication can be used concomitantly or be started after seeing what progress is made with CBT.